Sloppy Calls

     EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     The first run of your day is for a "sick party" at a skilled nursing facility close to your station. You just relieved one of the folks on the offgoing shift a little early so she could pick up her kids. You're responding with her partner, a good paramedic. The address is just down the street from your station, so you reach it in no time.

     When you arrive, you follow a caregiver to the bedside of a woman in her 70s. She is supine, naked and surrounded by three other caregivers. One of them is wearing the insignia of a student nurse from a local college. As you enter, they seem to be intent on cleaning the patient, and the odor of body lotion is pervasive. When they see you, they back away as though finished.

     The patient is awake and answering questions, but not speaking spontaneously. She knows who and where she is, she is not in obvious distress, and she is complaining of abdominal pain. Her skins are normal, but she has no peripheral pulses. Her lung sounds are clear. Your partner looks for an IV site and starts asking about the circumstances leading up to the call.

     Meanwhile, you fumble. You can't seem to do anything right. You omit half of the history, you misplace the meds, you forget the patient's name, you get your fingers tangled in tape, you can't seem to change the paper in the rhythm strip recorder, you drop a battery under the bed and you miswire the patient's 12-lead. When your partner points that out to you, the observers giggle. Now you're embarrassed, and you catch yourself fumbling with the trigger latch on the cot.

     Q. You're wishing you hadn't come in early. You're way better than this. What's wrong with your head today?
     A. If you haven't had this happen to you before now, consider yourself special. There's a medical term for it, CRI (for Cephalo-Rectal Impaction-or something like that). I think a California paramedic, Chris Olson, first described the phenomenon in about 1980. He may have been working with me, actually. Nobody has ever published a study on CRI, but it has been widely observed. It seems to occur in critical care providers at all experience levels, both in field and hospital settings. Chris observed that episodes occur randomly even in good caregivers, and postulated that CRI may be a precursor to Old-Timer's Disease.

     Q. That's fine, but this is not funny. It seems to happen when you least expect it, whether you're in the middle of acute-status calls or driving an emergency vehicle. What's happening to you?
     A. Occasional CRI occurs in normal, healthy people who are routinely subjected to stress and deprived of sleep. You should see a physician if it becomes frequent and intrusive, especially away from work. Otherwise it seems to be related to the simple fact that we are not perfect, and we are not machines.

     Q. How can you just explain all this away as inevitable, even in the best of us? People in crisis count on us to make the right observations and the right decisions for them, quickly and consistently. They can't afford for us to have bad days.
     A. I'm a big public advocate, and I agree with this perception of the public's expectations. But no matter how good you are, you (and the people you work with) are human. People hold us accountable for staying competent, for keeping our certificates current and our medicine up-to-date, for checking our equipment, for responding promptly to their emergencies, and for honestly caring about them and the ones they love most. They expect us to respect their safety and their dignity. They expect us to do our very best to help them, any time they call. But generally they don't expect us to be perfect.

Lucky for us.